Immunosuppressants

Question 1

Mycophenolate mofetil

Answer 1

OK with allopurinol

UGI / diarrhoea

Leukopenia

Skin cancer

Question 2

Tacrolimus / cyclosporin (calcineurin inhibitors)

Answer 2

Tacrolimus:
Monitor trough (5-10ng/mL)
Renal dysfunction
Alopecia
HTN

Cyclosporin:
Gum hypertrophy
Hirsutism
Gout

Question 3

Sirolimus / everolimus (mTOR inhibitors)

Answer 3

Monitor trough
Leukopenia
Hyperlipidemia
Proteinuria
Delay wound healing, CNI replacement pre-op and restart 1-3/12 post-op

Question 4

Azathioprine

Answer 4

More acute rejection than MMF

Question 5

Prednisone (steroids)

Answer 5

Acute rejection- pulsed high dose steroids, increase immunosuppression.

Maintenance.

Question 6

Prophylaxis

Answer 6

Bactrim for PJP (atovaquone alternative)
Influenza vaccine

1/12 post-op opportunistic infections:
- toxoplasma
- nocardia
- aspergillus
- viral infections (CMV)

6/12 post-op:
- PO valganciclovir for CMV, ganciclovir if CMV negative pt and CMV positive donor.

Tx. Stop immunosuppressants except steroids.